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Efficiency: Paradoxical Impacts of Technology - Southwest Airlines gone awry

July 31, 2009
by Joe Bormel
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Efficiency: Paradoxical Impacts of Technology
Southwest Airlines gone awry

Operational Efficiency

We dedicated this portion of our professional lives to improving healthcare delivery. In every other area of our lives, we enjoy faster and more convenient service, better quality products and services, all enabled by supply chain management, attention to logistics, and the availability of Web services that globally connect our browsers, iPhones, BlackBerries and Pre(s).

Last week, I donned a backpack, walked a mile to the grocery store, picked up a half dozen items, bar coded them as I shopped and put them in my backpack. When I arrived at checkout, the items stayed in my backpack. I bar coded the checkout scanner and my complete receipt of items appeared, along with all of the “frequent-shopper” discounts. I swiped my credit card, signed the pad and resumed my walk home. The entire checkout process was less than 30 seconds. No lines. No conveyor belt. A checkout clerk nearby offered to assist, but it wasn't necessary.

Bar-code self-check-out ( Too many Atkins' low carb bars?)

Of course, the milkman/breadman of my youth has now been replaced by the webvan. We place our main weekly grocery list online and it's delivered. No need for the walk, unless I need the exercise ... which I do.

The relevance to healthcare is obvious to everyone reading this. We've got bar code medication administration, which coordinates the final step in delivering medication to inpatients, delivering easier documentation, the five rights checks, documentation as a by-product of process, and other kinds of clinical decision support (e.g. a final opportunity to hold a heart slowing drug to a patient whose heart is already too slow).

Gone Awry

Today, I'm flying from Baltimore's BWI airport on Southwest Airlines. Southwest, we all remember, drove its costs down more than any other airline in the last 10 years, by taking all of the waste out of its processes. It's a great story and many of us have enjoyed the good parts.

When I went to check-in online, however, this time I received the message that online check-in was filled up and I should check in at the airport. I just wasted the 10 minutes it took me to get to that point.

When I got to the airport, the kiosk gave me a security clearance card but not a check-in. It advised me to check in at the gate.

With each of these touch points, Southwest had the opportunity to eliminate a downstream bottleneck for me and for them. And yet, their software actually set me up to stand in another line. A "no value add" line.

The experience was clearly inferior to the other airlines. I've never been denied an online check-in before. I've never had a kiosk refuse to assign me a boarding pass.

All of the "happy talk" on Southwest's Web site about fast, friendly service sent me the opposite message than they intended.

Take Home

As we race to improve the efficiency and effectiveness of care coordination and delivery, we need to remember that automation can, paradoxically, make things slower and more expensive. We need to carefully design, analyze, test, and monitor our new processes. These aren't simply theoretical or rare occurrences. It's well known to network engineers that adding capacity to a network can make it slower. One such effect is called Braess's paradox and is elaborated here: )

Braess's paradox, credited to the mathematician Dietrich Braess,
states that adding extra capacity to a network,
when the moving entities selfishly choose their route,
can in some cases reduce overall performance.

Another example comes from India. A colleague who recently returned said that after they added a new central overpass bridge, the traffic congestion clearly got immediately worse.

At least the technology now allows me to write these blog posts while I'm waiting in line, from anywhere!

A footnote (from Wikipedia article above): How rare is the Braess Paradox? It's about a 50/50 proposition.
For example, in 1990, the closing of 42nd street in New York City reduced the amount of congestion in the area.




Although the logistics on Southwest were, for the first time, very disappointing, I would be remiss in not pointing out the good stuff.

  • Pictured here are the cushy seats for passengers waiting to board.  They were at both airports for this trip.  (atypical for my usual airline)
  • Those seats, and the counters in the background had ample electrical outlets.  (atypical for my usual airline)
  • The gate team (once I waited through what should have been an unnecessary line) was very friendly and helpful.
  • The flight service itself, like McDonalds, was highly consistent, predictable and met the need; it was also a good value.

I understand your venting when an otherwise dependable system breaks down . . . particularly at more than one point in the process. But I think it's even more important that after thinking about your post, you positioned things in proper perspective. Looks like a certain professor, police officer and president could take lessons from you! Although I'll give the cop credit for being the person who appears to be the real deal-maker and adult at the end of this unfortunate situation. Who'd a thought?

Anyway, your post really struck home today. I was expecting a very important document to arrive that was sent to me via USPS Express Mail. I've used and been the recipient of EM since its inception, and had never once, before today, had a problem. I certainly can't say that for UPS, and especially FedEx.

But there I was, found wanting with a tracking note informing me that my delivery had been "misdirected."

Over the course of this day, my anger subsided somewhat, and I realized that overall, the system's performance had been so good for such a long period of time, I'd better calm down and keep my frustration in perspective.

Thanks for your post. Guess in the end, regardless of how efficient technology becomes, nothing, as is also the fact with people, is perfect.


Thanks Jack and IA for your feedback.

Jack, you brought up the related issue of rising expectations regarding service levels. We clearly do get spoiled when the technology works well and then, occasionally is imperfect.

IA, blissfully, I'm flying less, so my skills at optimizing my flying behaviors with SWA were a factor. I hope my point wasn't lost though. On-line check in at eight hours before departure time should still work at producing an on-line check in. Maybe not the highest rank, but the customer experience should still be positive ... which it clearly wasn't.

I think you're comment highlights what Braess was talking about. When we design systems, we need to make sure that added capacity doesn't degrade the experience (the service level agreement) for the entire community.

We discussed that a bit in the Gremlins post a few weeks ago. If one group of users can significantly degrade the performance of other users, the design is going to produce sorrow and pain for the CIO held accountable for the total system. In this case, I'm glad that you can check-in 24 hours prior from your blackberry; if that pushes me behind all of the B's and C's priority passengers when I'm denied on-line check in hours before the flight, that's inefficient ... for me, those like me, and for SWA.  As Jack detected in his note, inefficient is putting it nicely.

You need to fly SWA more. You can do the on-line check in with your Blackberry 24 hours prior. No longer need to stay up until midnight for one of the coveted A slots.

Another airline that I flew relatively recently let me get my check-in on my iPhone. I was able to use that to get through security and then held my iPhone over the scanner at the gate when boarding. It took a little maneuvering until the scanner read the barcode off the screen, but it worked.

Joe Bormel

Healthcare IT Consutant

Joe Bormel